Provider Demographics
NPI:1700897741
Name:SY, MARIA LILIBETH TAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA LILIBETH
Middle Name:TAN
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 NOREN ST
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2756
Mailing Address - Country:US
Mailing Address - Phone:818-787-5800
Mailing Address - Fax:818-787-5810
Practice Address - Street 1:8162 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4806
Practice Address - Country:US
Practice Address - Phone:818-787-5800
Practice Address - Fax:818-787-5810
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52234208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099890Medicaid
CAA52234OtherMEDICAL LICENSE NUMBER
CAH47429Medicare UPIN